Cardiovascular Health

Cardiac Surgery Quality and Outcomes

At Stanford Health Care, we measure a variety of cardiac procedures and patient volumes to see how well our patients are doing. We look at the risk-adjusted mortality rate (RAMR) to compare survival of our patients with other hospitals in the nation. The lower the mortality rate, the better.

Stanford Health Care has:

• Lower mortality rates than average for major cardiac procedures
• Lower mortality rates than average for an isolated aortic valve replacement (AVR)
• High volume of TAVR patients with severe aortic stenosis

Lower mortality rates than average for major cardiac procedures

We've seen increased survival rates compared to the average national hospital. Our surgeons continue to accept referrals for some of the most complex cases for patients who were previously denied surgery at other hospitals.

We look at the RAMR percentage for the most commonly performed heart surgeries, 30 days post-surgery:

• Coronary artery bypass graft (CABG) surgery
• Aortic valve replacement (AVR)
• Mitral valve replacement (MVR)

This metric combines the data from all three major cardiac procedures. The lower the RAMR percentage, the better. A lower mortality rate means a higher survival rate.

Lower mortality rates than average for an isolated aortic valve replacement (AVR)

We are a high volume surgical valve center with consistently lower 30-day mortality rates than the national average for an isolated aortic valve replacement overall in the past four years.

In 2009, we had a high risk, inoperable transcatheter aortic valve replacement (TAVR) clinical trial running. The Society of Thoracic Surgeons (STS) included these clinical trial results, which is why our mortality rates in 2009 were higher than the STS national average.

The lower the RAMR percentage, the better. A lower mortality rate means a higher survival rate.

High volume of TAVR patients with severe aortic stenosis

We have been performing the TAVR procedure since the start of the U.S. clinical trials. As a result, our doctors and clinical teams are very experienced with this procedure.

About risk-adjusted mortality rate (RAMR)

Risk adjusted means that individual patient characteristics that contribute to mortality are recorded (medical history, risk factors, surgery type, etc.) and analyzed the same way for each hospital across the country.

Once patient differences are taken into account, the Society of Thoracic Surgeons (STS) risk adjustment analysis provides a national report using data submitted voluntarily by over 1,000 U.S. hospitals. Their analysis fairly compares all the hospitals involved, providing objective data for national hospital comparisons.

A RAMR below the national average over time is a good indicator of the consistency and quality of a hospital's cardiac surgery performance. The lower a hospital's RAMR percentage, the better their results.